28-week premature infants are usually born with Respiratory Distress and need ventilator support in order to survive. However, because of all the associated complications…
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▼

M.Cur.

28-week premature infants are usually born with Respiratory Distress and need ventilator support in order to survive. However, because of all the associated complications of ventilation of premature infants, it is the practice in the NICU's in this studies to extubate these infants as soon as possible to either nasal continuous positive airway pressure (nCPAP) or nasal cannula (nc). For this study the choice of ventilation was High-Frequency Oscillation (HFO). It is known that during HFOV, Fi02 and MAP constitute the oxygenation needed to ventilate these infants. During weaning the Fi02 is reduced to :s 30% and the MAP gradually to :s 8-10 cm H20 to enable extubation. There are not enough guidelines as to the ideal MAP at which to extubate a HFOV 28-week premature infant to nCPAP or nco The purpose of this study was, firstly, to determine the recommended optimal MAP to successfully extubate a 28-week HFOV premature infant to either nCPAP or nc and, secondly, to formulate guidelines and recommendations for use by the attending neonatal nursing staff, doctors and clinicians for optimal nursing and management of the HFOV premature infant. This is a non-experimental quantitative study with a retrospective, descriptive survey, case study design. All 28-week premature infants that were initially ventilated on a HFOV during the period May 2000 to September 2002 in two private Neonatal Intensive Care Units in Gauteng and extubated to nCPAP or nc were incorporated into this study. The study was done in 3 phases. The first involved an in-depth literature survey in which the physiological and biographical variables that were included in the data collection instrument were identified. The second phase involved collecting the data from the infant's medical files, analysing the data and identifying any correlation of the data. In the third phase guidelines and recommendations for neonatal nursing staff, doctors and any attending clinicians were formulated. The initial settings of the HFOV, as well as the settings at a MAP of 8 cm H20, and the settings of the HFOV prior to extubation were recorded and analysed. The premature infant's initial blood gas and peripheral saturation after commencement of ventilation, as well as at a MAP of 8 cm H20 and prior extubation were recorded and analysed. The physiological stability of the premature infants, 12 hours after extubation, formed the criteria of successful extubation and any need for re-intubations was considered failure criteria. There are a lack of protocols and guidelines for neonatal nurses, doctors and clinicians as to guide them in the nursing of HFOV 28-week premature infants. The analysed data assists in drawing up guidelines for nursing the 28-week premature HFOV infant.

Neonates born with respiratory distress require supplementary oxygen. In some cases it is necessary to ventilate these neonates in order to obtain adequate tissue…
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▼

M.Cur.

Neonates born with respiratory distress require supplementary oxygen. In some cases it is necessary to ventilate these neonates in order to obtain adequate tissue oxygenation. Due to the potential complications of mechanical ventilation it is necessary to extubate the neonate as soon as possible after intubation and administer supplementary oxygen by an alternate method. Any form of oxygen therapy carries the risk of oxygen toxicity. It is therefore essential that the method of oxygen therapy opted for after extubation will result in the infant being weaned in the shortest time possible. In the two NICUs from which the sample was taken for this study, neonates are currently extubated and placed either in a head box, on nasal CP AP or on a nasal cannula, these being the methods used to administer oxygen to a neonate. The decision regarding the method of choice is currently directed by customary practices rather than physiological variables as indicators/criteria of effectiveness. The questions that arise from the research problem are as follows: • Which physiological variables should be considered when faced with the decision regarding the method of oxygen therapy to initiate after extubation of a neonate? • Are there any differences in the effectiveness of the two methods of oxygen therapy, namely headbox and nasal cannula, after extubation of a neonate? The purpose of this study was to compare two methods of oxygen therapy, after extubation of the neonate with respiratory distress syndrome, in an attempt to formulate guidelines; based on physiological variables as criteria/indicators of effectiveness. After analyzing the data, as described in Chapter 4, it became evident that it would not be possible to formulate guidelines. Therefore only a comparison was done between the two methods of oxygen therapy (headbox and nasal cannula,) based on both biographical and physiological variables as criteria/indicators, to determine whether there were any significant differences in the effectiveness of the two methods after extubation of the neonate.

Van Schoor, D. (2011). A comparison of two methods of oxygen therapy after extubation of a neonate. (Thesis). University of Johannesburg. Retrieved from http://hdl.handle.net/10210/4188

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Van Schoor, Diane. “A comparison of two methods of oxygen therapy after extubation of a neonate.” 2011. Thesis, University of Johannesburg. Accessed September 15, 2019.
http://hdl.handle.net/10210/4188.

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Van Schoor D. A comparison of two methods of oxygen therapy after extubation of a neonate. [Internet] [Thesis]. University of Johannesburg; 2011. [cited 2019 Sep 15].
Available from: http://hdl.handle.net/10210/4188.

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Van Schoor D. A comparison of two methods of oxygen therapy after extubation of a neonate. [Thesis]. University of Johannesburg; 2011. Available from: http://hdl.handle.net/10210/4188

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

University of Zambia

3.
Mukosha, Moses.
The prevalence of hyponatremia and effects of aminophylline on serum sodium ions in premature neonates admitted to Neonatal Intensive Care Unit, at the University Teaching Hospital, Lusaka, Zambia
.

► BACKGROUND: Hyponatremia, defined as serum sodium less than 135mmol/l, is a very common disorder in neonates. It accounts for about 30% of hospitalised cases worldwide,…
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▼ BACKGROUND: Hyponatremia, defined as serum sodium less than 135mmol/l, is a very common disorder in neonates. It accounts for about 30% of hospitalised cases worldwide, especially in premature neonates admitted to an intensive care unit. The overall morbidity and mortality from hyponatremia worldwide is reported to be at 42%. Studies done in adults and neonates have demonstrated that aminophylline, an adenosine A1 receptor antagonist, has a diuretic effect and has been implicated in lowering serum sodium levels in premature neonates. However these studies did not address the need for sodium supplementation for neonates receiving aminophylline. This study aimed at determining the prevalence of hyponatremia in premature neonates, and the effects of aminophylline administration on serum sodium levels in Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital (UTH).
METHOD: A cross sectional study design was employed to study 322 premature neonates who were enrolled between October 2013 and February 2014. The mean weight and mean gestational age of the participants was 1.44kg and 31.85 weeks respectively. Out of the 322 participants 188 met the criteria for aminophylline administration and were given a loading dose. As part of routine management, blood samples were collected on admission and 12hours after a loading dose of aminophylline. The blood samples were taken to UTH paediatrics laboratory for analysis. The analysis involved measuring the serum sodium levels using Pentra C400.
RESULTS: According to the findings, this study shows that in premature neonates the prevalence of hyponatremia in NICU at UTH is 51%. The study further established that the majority of the premature neonates showed a significant decrease in serum sodium levels after taking a loading dose of aminophylline with P-value 0.0000. Among the factors that the study looked at, weight and gestational age, were significantly associated with hyponatremia with P-values 0.041 and 0.009 respectively.
CONCLUSION: The prevalence of hyponatremia in NICU at UTH is significantly high and using aminophylline in premature neonates lowers serum sodium levels and sodium supplements may be required. Among the factors that the study looked at, only weight and gestational age
were significantly associated with hyponatremia in premature neonates admitted to NICU at
UTH.
Nevertheless, the renal actions of aminophylline in premature neonates merit further
investigation.

Mukosha, M. (2015). The prevalence of hyponatremia and effects of aminophylline on serum sodium ions in premature neonates admitted to Neonatal Intensive Care Unit, at the University Teaching Hospital, Lusaka, Zambia
. (Thesis). University of Zambia. Retrieved from http://hdl.handle.net/123456789/3662

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Mukosha M. The prevalence of hyponatremia and effects of aminophylline on serum sodium ions in premature neonates admitted to Neonatal Intensive Care Unit, at the University Teaching Hospital, Lusaka, Zambia
. [Thesis]. University of Zambia; 2015. Available from: http://hdl.handle.net/123456789/3662

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Massey University

4.
Greensill, Susan Elizabeth.
What is the effect of suctioning and frequency on oxygenation and bradycardias in infants [less than and equal to] 30 weeks gestation requiring Bubble Continuous Positive Airway Pressure (CPAP)?.

► Background: Previous research around suctioning premature infants has focused on endotracheal suctioning. Continuous positive airway pressure (CPAP) has become a major mode of respiratory support.…
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▼ Background: Previous research around suctioning premature infants has focused on endotracheal suctioning. Continuous positive airway pressure (CPAP) has become a major mode of respiratory support. Consequently, there is a need for research that is relevant to this mode of respiratory support.
Aim: To determine the effect suctioning and suctioning frequency has on oxygen saturation levels and bradycardias in infants =30 weeks gestation on “bubble” CPAP.
Method: The research comprised of two parts:
• An observational study to determine the effect of suctioning on oxygen saturation, desaturations, and bradycardias.
• A randomised crossover study to determine the effect of frequency of suctioning on oxygen saturation, desaturations, and bradycardias.
Results: Part One: Analysis demonstrated that increased suctioning frequency significantly decreased oxygen saturation levels and resulted in more desaturations. However, one more desaturation per hour required 5.3 and 7 more suctioning episodes each day for desaturations of =10 seconds and =60 seconds respectively. Of note was the increased likelihood of desaturations when the suctioning interval was longer. An increase interval of 1 hour 40 minutes between suctioning times led to one more desaturation =10 seconds per hour, with one more desaturation =60 seconds with 3½ hours increase in interval. Bradycardias were also significantly increased by one per hour, when suctioning frequency increased by 15 intervals per day. Conversely, the odds of a bradycardia occurring if the suctioning interval increased one hour was 1.9. Part Two: Analysis demonstrated that overall there were less desaturations and bradycardias with 2 hourly suctioning compared to 4 hourly. However, numbers were too small to determine statistical significance. Data from the effect of suctioning, for both parts, demonstrated prolonged periods of recovery for infants, with minimal or no change in supplemental oxygen, which may have affected results.
Conclusion: Significance was demonstrated in relation to more desaturations and bradycardias with increased frequency of suctioning in Part One, though the prolonged recovery time may have influenced these outcomes. Of more significance were the findings that demonstrated increased desaturations and bradycardias with longer intervals between suctioning. Results from Part Two were inconclusive due to small numbers of participants. This study provides a baseline for evidence on suctioning premature infants on CPAP, guideline development and a foundation for future research.

► The purpose of this study was to determine the limitations and strengths of neonatal and pediatric critical care clinical education rotations to adequately prepare respiratory…
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▼ The purpose of this study was to determine the limitations and strengths of neonatal and pediatric critical care clinical education rotations to adequately prepare respiratory care students. All respiratory care programs have a curriculum built around procedural skills assessment in the clinical environment and lecture instruction in the classroom. Therefore, clinical education is an accreditation requirement and is an invaluable part of every respiratory care curriculum. Situated learning was the theoretical perspective and constructivism was the theory of learning that guided my actions, assumptions and perspectives. Using a phenomenological research approach 14 participants were interviewed to gain an understanding of their perceptions of the neonatal and pediatric clinical rotation. An interview guide was used to keep the participants focused on the study’s purpose. However, participants were encouraged to speak openly about their clinical experiences. Interviews were recorded and transcribed prior to analysis. The lived experiences of these participants provided the data required to answer the research questions and to generate future areas of research. Results indicate that participation in respiratory care procedures in the clinical environment is preferred and the ability to engage in direct patient care is a major strength and potentially a limitation of the rotation. The neonatal and pediatric environment offers unique challenges to respiratory car students that could potentially inhibit active involvement with patient care. The clinical instructors play a huge role toward maximizing student involvement and should be viewed as such by directors of clinical education. Preparatory activities prior to and after the neonatal and pediatric clinical rotation should be strongly considered by respiratory care programs. Student motivation to engage in clinical activities and clinical instructor trust in student abilities appear to play dual roles in neonatal and pediatric clinical outcomes. These results have definite implications on practice, policy and future theory development. This study provided a beginning source for considering changes in current neonatal and pediatric clinical curriculum. This study will assist directors of clinical education when planning and altering hospital rotations. From a policy consideration the results of this study offer a perspective on neonatal and pediatric clinical rotations that impact accreditation standard development and changes. This study offers a means of comparison of respiratory care students and clinical outcomes to those of other nursing and allied health studies. This study extends the available literature related to perceptions of clinical education. The revision of the conceptual framework will guide researchers efforts in other projects. This study demonstrates the need for research related to clinical education and offers additional recommendations for future studies. Clinical survey development and distribution is the next phase to generate data on clinical…
Advisors/Committee Members: Furney, Steven R. (advisor), Reardon, Robert F. (committee member), Ross-Gordon, Jovita M. (committee member), Marshall, S. Gregory (committee member).

Russian CJ. A Qualitative Study To Determine Perceptions Of Neonatal And Pediatric Clinical Education In An Allied Health Profession. [Doctoral Dissertation]. Texas State University – San Marcos; 2014. Available from: https://digital.library.txstate.edu/handle/10877/5252

► Neonatal resuscitation is used in the management of neonates with birth asphyxia and respiratory distress few hours after birth. The popularity of neonatal resuscitation is…
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▼ Neonatal resuscitation is used in the management of neonates with birth asphyxia
and respiratory distress few hours after birth. The popularity of neonatal
resuscitation is increasing in the decade with the introduction of Helping Babies
Breath (HBB) and Emergency Obstetric and New-born Care (EmONC) trainings.
This study was aimed at determining compliance with the World Health
Organisation (WHO) neonatal resuscitation guidelines and its related factors by
medical doctors and midwives in Kitwe District Health delivery facilities.
A descriptive cross sectional study design was used. Purposive sampling method
was used to select the appropriate sample. A total number of 5 medical doctors
and 81 midwives from Kitwe Central Hospital and Kitwe District Health delivery
facility answered a self-administered questionnaire. Twenty (20) participants out
of the 86 respondents were observed conducting resuscitation using the
observation checklist that was adopted from Essential Newborn Care training
guide by World Health Organisation.
Data was analysed using the SPSS version 20.0 software and was presented in
the form of frequency tables and cross tabulation, pie charts and bar charts to
communicate the results easily. Chi- square test was used to test the associations
between the dependant and independent variables. The factors associated with
compliance were analysed using the multivariate binary logistical regression
model. A 5% level of significance was set and p-value of 0.05 or less was
considered statistically significant.
This study revealed that 82.6% of the respondents did not comply with WHO
neonatal resuscitation guidelines and 79 % of the respondents had moderate
knowledge on neonatal resuscitation. The findings showed that 69.8% of the
respondents had positive attitude towards neonatal resuscitation. On the
availability of equipment, the study showed that 66% of the equipment was
available. Further the study revealed that 84.9% of the respondents did not attend
any in house training.

Peters, K. L. (1983). The physiological responses of the respiratory distressed
neonate to two forms of chest physiotherapy. (Masters Thesis). University of Alberta. Retrieved from https://era.library.ualberta.ca/files/x059c917m

Peters KL. The physiological responses of the respiratory distressed
neonate to two forms of chest physiotherapy. [Internet] [Masters thesis]. University of Alberta; 1983. [cited 2019 Sep 15].
Available from: https://era.library.ualberta.ca/files/x059c917m.

Council of Science Editors:

Peters KL. The physiological responses of the respiratory distressed
neonate to two forms of chest physiotherapy. [Masters Thesis]. University of Alberta; 1983. Available from: https://era.library.ualberta.ca/files/x059c917m

► This investigation aimed to objectively measure physiological deficiencies across the continuum of airway protection and clinical feeding and swallowing severity in children with spastic cerebral…
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▼ This investigation aimed to objectively measure physiological deficiencies across the continuum of airway protection and clinical feeding and swallowing severity in children with spastic cerebral palsy (SCP), and to make comparisons with a healthy control group. Eleven children with SCP (GMFCS I-V) and 10 controls (mean age: 7+ 2 years) were tested. Results revealed significantly impaired oropharyngeal function and greater clinical feeding and swallowing severity for children with SCP. These children also demonstrated impaired respiratory-swallow coordination evidenced by frequent post-swallow inhalation across all bolus types. Reduced cough volume acceleration was also observed in children with SCP compared to controls. In the SCP group, significant correlations with clinical feeding and swallowing severity were observed with oral praxis and post-swallow inhalation. Additionally, clinical feeding and swallowing severity and peak expiratory flow rate were significantly correlated with gross motor function. This is the first study to objectively identify the co-occurrence of dysphagia and dystussia in children with SCP, and to quantify factors underlying these deficits. Future research should address functional deficits along the continuum of airway protection in both assessment and treatment paradigms in order to maximize the quality of life for this population.

► <h1><a>ABSTRACT</a></h1> BACKGROUND:RT was primarily introduced in Saudi Arabia by military hospitals beginning in the late 1970s. Currently, Saudi Arabia does not have a certification board…
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▼ <h1><a>ABSTRACT</a></h1>
BACKGROUND:RT was primarily introduced in Saudi Arabia by military hospitals beginning in the late 1970s. Currently, Saudi Arabia does not have a certification board for RT and, therefore, all of the RTs in Saudi Arabia who graduated from national colleges do not have credentials. PURPOSE: The purpose of the study was to evaluate the need for developing a board for RT in Saudi Arabia, and also to determine how Saudi RTs perceived the value of certification board for RT. METHODS: Data were collected through a descriptive survey. The survey was used to examine the assessment of need to develop SBRT, and to determine how Saudi RTs perceived the value of certification. The web- link survey was e-mailed to all RTs who are member of the Saudi Society for Respiratory Care (SCRC), which has total of 750 members. The survey consisted of two parts: Assessment of need for SBRT, and perceived value certification tool (PVCT). RESULTS: two hundreds and forty responded with a response rate of 32%. Eighty percent of the participants were male, and 18% were female. Fifty three percent of the participants identified themselves as credentialed RTs, and 46% participants were non-credentialed RTs. The participants’ degree level reported was Associate degree (13%), Bachelor’s degree (63%), Master’s degree (21%), and Doctoral degree (3%). Ninety percent of the participants work for the government institutions, whereas 10 % work for the private institutions. There was no statistically significant difference at the level of 0.05 between credentialed RTs and non-credentialed in terms of the perception towards the development of SBRT (z = -1.81, p= .071). There is also no statistically significant difference between credentialed and non-credentialed (p =. 779) at the level of .05 in terms of how they perceived the certification value. CONCLUSION: These findings can provide SRTs the opportunity to promote and discuss the development of the KSA certification board within the field of RT.
Advisors/Committee Members: Lynda T. Goodfellow, Ed.D., RRT, FAARC, Douglas S. Gardenhire, Ed.D, RRT-NPS, FAARC, Ralph “Chip” Zimmerman, MSM, RRT-NPS.

► Rehabilitation was originally defined by the Council of Rehabilitation in 1942. Their definition then was "the restoration of the individual to the fullest medical, mental,…
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▼ Rehabilitation was originally defined by the Council of Rehabilitation in 1942. Their definition then was "the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable" (American Association of Cardiovascular and Pulmonary Rehabilitation, 1993). This definition was expanded in 1974 by the American College of Chest Physicians Committee on Pulmonary Rehabilitation to include patients with lung disease. Their statement clarified the best care for pulmonary patients and defined the role of pulmonary rehabilitation. Pulmonary rehabilitation programs were then further defined with optimum sequences of treatment, benefits and limitations by the American Thoracic Society (ATS) in 1984 (AACVPR, 1993).

► Monogenic lung surfactant deficiencies are fatal and lead to death in neonates within a year of life unless they receive a lung transplant. Deficiencies such…
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▼ Monogenic lung surfactant deficiencies are fatal and lead to death in neonates within a year of life unless they receive a lung transplant. Deficiencies such as Surfactant protein-B (SP-B) deficiency or ATP-binding cassette subfamily A member 3 (ABCA3) deficiency lead to decreased functionality of lung surfactant, atelectasis, and severe respiratory distress. We investigated three different strategies to deliver therapeutic transgenes for transient expression to prolong life, or integrate corrective genes to cure the disorder. The first method utilized a single AAV6.2FF vector to deliver SP-B cDNA to a deficient mouse model and we observed an extension of survival. The second method employed a split-vector system to deliver both halves of ABCA3 cDNA separately to recombine in vivo, and was found to result in efficient expression of full length ABCA3 in the distal airways of mice. Thirdly, we developed an AAV6.2FF- mediated CRISPR/Cas9 gene-editing platform that caused efficient insertion and expression of promoterless transgenes in dividing alveolar type II cells. Together, these findings show efficacy of AAV-based gene therapy options to either extend life, or replace a gene in dividing cells to correct lung surfactant deficiency.
Advisors/Committee Members: Wootton, Sarah (advisor).

► BACKGROUND: Clinical facilities are essential components not only for health care delivery systems but also for health care education programs. The clinical learning environment…
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▼ BACKGROUND: Clinical facilities are essential components not only for health care delivery systems but also for health care education programs. The clinical learning environment is important in training the future workforce in healthcare. Respiratorytherapy education programs face several issues with the need to prepare a proper learning environment in different clinical settings. PURPOSE: The purpose of this study was to determine the perceptions of respiratorytherapy students on the learning environment of clinical facilities affiliated with a respiratorytherapy program at an urban state university. METHODS: This study used an exploratory research design to evaluate the essential aspects of a clinical learning environment in respiratorytherapy education. A self-reporting survey was utilized to gather data from 34 respiratorytherapy students regarding their perception about the effectiveness of clinical facilities in respiratorytherapy education. The researcher utilized The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale that was developed by Sarrikoski et al. (2008). The CLES+T evaluation scale was adapted and modified after a written agreement from the author. The survey included three main domains, which are the clinical learning environment (18 items), the supervision relationship (15 items), and the role of clinical instructors (9 items). Thirty-two students participated in the survey with a response rate of 94.1%. RESULTS: Responses included two groups of students: the second year undergraduate (68.8%) and graduate students (31.3%), with 75% being female participants. The results obtained from the study indicated that both graduate and undergraduate respiratorytherapy students gave high mean scores to the learning environment of the clinical facilities, supervisory relationship and the roles of clinical instructors. A statistically significant data was obtained pertaining to the difference of perceptions regarding the multi-dimensional learning between the graduate and undergraduate students. The graduate students evaluated that “the learning situation are multi-dimensional” more than the undergraduate students (p = 0.03). Findings of this study showed that female students had higher ratings than male students in all evaluations of clinical facilities. However, only one dimension of leadership style stating that “the effort of individual employees was appreciated” was statistically significant (p=0.03). The results stating, the presence of a significant percentage of the students with lack of successful private supervision and high percentage of failed supervisory relationship, are in contrast with the fact that clinical learning plays a vital role in the respiratorytherapy education. It is also contrasting that majority of the students experienced team supervision, which is against the philosophy and principles of individualization. CONCLUSION: Since…
Advisors/Committee Members: Dr. Arzu Ari, Robert Murray, Ralph Zimmerman.

Munro, D. F. (2002). The effects of a cervical collar in the treatment of apnea
of prematurity. (Masters Thesis). University of Alberta. Retrieved from https://era.library.ualberta.ca/files/4q77ft79n

Chicago Manual of Style (16th Edition):

Munro, Denise Florence. “The effects of a cervical collar in the treatment of apnea
of prematurity.” 2002. Masters Thesis, University of Alberta. Accessed September 15, 2019.
https://era.library.ualberta.ca/files/4q77ft79n.

Munro DF. The effects of a cervical collar in the treatment of apnea
of prematurity. [Internet] [Masters thesis]. University of Alberta; 2002. [cited 2019 Sep 15].
Available from: https://era.library.ualberta.ca/files/4q77ft79n.

Council of Science Editors:

Munro DF. The effects of a cervical collar in the treatment of apnea
of prematurity. [Masters Thesis]. University of Alberta; 2002. Available from: https://era.library.ualberta.ca/files/4q77ft79n

University of Western Australia

19.
Francis, Jacinta Piwen.
Maternal and neonatal immune responses to pneumococcal protein antigens in relation to risk for early upper respiratory tract (URT) pneumococcal carriage in a high-risk population in Papua New Guinea.

► [Truncated abstract] Pneumococcal exposure is high and life-long in developing countries including Papua New Guinea (PNG), with children under 2 years of age being at…
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▼ [Truncated abstract] Pneumococcal exposure is high and life-long in developing countries including Papua New Guinea (PNG), with children under 2 years of age being at most risk for early upper respiratory tract pneumococcal carriage and infection. Deaths from pneumococcal diseases such as pneumonia and meningitis are common and likely the result of an absence of vaccination programmes. The need for effective and affordable pneumococcal vaccines has led to the testing of protein antigens including pneumolysin (Ply) and pneumococcal surface protein A (PspA) as novel vaccine antigens. Little is known on the immune responses to these proteins in humans, particularly in high-risk populations where such vaccines will be of most benefit. In this study, we examined the roles of naturally acquired antibody and cellular immune responses in mothers and newborns to Ply and PspA family 1 (PspA1) and family 2 (PspA2) in protection against or risk for early carriage in a high-risk PNG population. Antibodies to Ply, PspA1 and PspA2 were measured in plasmas of 241 mothers and 115 newborns (cords) from PNG, and 50 Australian mothers using an enzyme-linked immunosorbent assay (ELISA). Pernasal swabs were collected from PNG mothers at the time of delivery, one month post-partum, and weekly within the first month of life from their newborns to determine pneumococcal carriage. Cellular immune responses to Ply, PspA1 and PspA2, the TLR2/TLR4 ligands, LTA and LPS and to PHA were measured in cord blood mononuclear cells (CBMC) of 84 PNG versus 33 Australian newborns. Innate and T-cell cytokine responses in the PNG newborns were then analysed to determine their effect on infant pneumococcal carriage. ... No protective effect against infant pneumococcal carriage was observed with maternal and cord IgG levels for all antigens. Maternal carriage at time of delivery increased the risk for infant pneumococcal carriage in the first month of life (HR: 1.93, 95% CI 1.36 – 2.73, p = 0.001) with 70% of infants being colonised. Papua New Guinean newborns produced higher innate IL-10 and IFN-γ (p = 0.003) and TNF-α (p < 0.001) to Ply compared to Australian newborns with no significant differences observed for IL-6 or IL-12. IFN-γ responses to LPS and LTA (p = 0.005 and p < 0.001) were higher in PNG than Australian newborns, while IL-6, IL-10 (p < 0.001) and TNF-α (p = 0.002) to LPS with LTA-induced IL-6 and IL-10 (p < 0.001) were higher in Australian newborns. T-cell IL-5, IL-10, IL-13, IFN-γ, IL-6 and TNF-α response levels to PspA and PHA stimulation were significantly high in PNG newborns. No differences were observed for cytokine responses to Ply and PspA between PNG infant pneumococci carriers and non-carriers. Papua New Guinean infants are colonised by pneumococci very early in life and this may be influenced by high maternal carriage rates. PspA- and Ply-IgG levels are high in PNG mothers and undergo cross placental transfer but do not appear to be protective against early pneumococcal carriage. In PNG newborns, PspA elicits T-cell responses,…

Francis, J. P. (2008). Maternal and neonatal immune responses to pneumococcal protein antigens in relation to risk for early upper respiratory tract (URT) pneumococcal carriage in a high-risk population in Papua New Guinea. (Masters Thesis). University of Western Australia. Retrieved from http://repository.uwa.edu.au:80/R/?func=dbin-jump-full&object_id=12711&local_base=GEN01-INS01

Chicago Manual of Style (16th Edition):

Francis, Jacinta Piwen. “Maternal and neonatal immune responses to pneumococcal protein antigens in relation to risk for early upper respiratory tract (URT) pneumococcal carriage in a high-risk population in Papua New Guinea.” 2008. Masters Thesis, University of Western Australia. Accessed September 15, 2019.
http://repository.uwa.edu.au:80/R/?func=dbin-jump-full&object_id=12711&local_base=GEN01-INS01.

Francis JP. Maternal and neonatal immune responses to pneumococcal protein antigens in relation to risk for early upper respiratory tract (URT) pneumococcal carriage in a high-risk population in Papua New Guinea. [Internet] [Masters thesis]. University of Western Australia; 2008. [cited 2019 Sep 15].
Available from: http://repository.uwa.edu.au:80/R/?func=dbin-jump-full&object_id=12711&local_base=GEN01-INS01.

Council of Science Editors:

Francis JP. Maternal and neonatal immune responses to pneumococcal protein antigens in relation to risk for early upper respiratory tract (URT) pneumococcal carriage in a high-risk population in Papua New Guinea. [Masters Thesis]. University of Western Australia; 2008. Available from: http://repository.uwa.edu.au:80/R/?func=dbin-jump-full&object_id=12711&local_base=GEN01-INS01

► ENGLISH ABSTRACT: The thermal regulation response of a neonate has to maintain temperature homeostasis, thus resisting the changes to core temperature caused by the unstable…
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▼ ENGLISH ABSTRACT: The thermal regulation response of a neonate has to maintain temperature homeostasis,
thus resisting the changes to core temperature caused by the unstable external
environment. In this thesis a theoretical thermal regulation response model for human
infants subject to a well-defined environment is presented. This model will aid in
understanding the influences of environmental effects on core and skin temperature. The
respiratory system was also included in the thermal regulation response model.
A literature study was undertaken emphasising thermal regulation of neonates. The blood
circulation system, skin tissue physiology and the respiratory system physiology were
reviewed and helped to provide a better understanding of the thermal regulation
mechanisms and how heat transfer theory can be used to analyse heat loss in neonates.
The thermal heat transfer properties of skin tissue was specified and used in the
development of the theoretical simulation model. The bioheat equation developed by
Pennes was reviewed as well as a mathematical model developed by Fiala et al.
The theoretical model was developed by applying the conservation of energy and the
applicable properties to one dimensional layers to generate a set of time dependent
differential equations. The set of equations was solved using an explicit numerical finite
difference method, given the initial conditions. The mathematical model included heat
loss through the skin, heat loss through the respiratory system, as well as the effect of
environments (in incubator or in a bassinette) with different temperatures, relative
humidity’s and air velocities. Clothing was also incorporated.
A clinical trial was conducted to facilitate a better understanding of thermal stability in
neonates. The data acquired during the clinical trial was also used to verify/validate the
theoretical simulation model. The results from the simulation temperatures were
compared with the average outer skin layer temperature measured during the clinical trial
and an average deviation of only 0.22 °C was found, thereby proving that the simulation
model gives realistic results.
An experimental respiratory model was designed to simulate the respiratory system and
illustrate the functioning thereof with regards to heat transfer. This was done by designing
an experimental mechanical lung apparatus. The apparatus was tested and successfully
imitated the respiratory system with regards to heat transfer. The results obtained from
this experiment indicated that the trachea must be moistened continuously in order to
condition inhaled air. The outcome of this project identified two possible applications. For the first application
it can be used as a test tool for quickly evaluating the influence of different environmental
conditions in the transient temperature distribution of neonates. The second application
would be to enable medical professionals to monitor the influence of the thermal
environment, including the temperature, relative humidity and…
Advisors/Committee Members: Dobson, Robert T., Stellenbosch University. Faculty of Engineering. Department of Mechanical and Mechatronic Engineering..

▼ Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive.
CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS.
Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals.
Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape.
Study design: Prospective cohort analytical study with an historic control group (HCG).
Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital.
Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project.
Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The…
Advisors/Committee Members: Conradie, Hoffie, University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.

► This study was undertaken primarily to investigate the plasma protein system in infants with IRDS, as compared with healthy premature infants, as it had previously…
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▼ This study was undertaken primarily to investigate the plasma protein system in infants with IRDS, as compared with healthy premature infants, as it had previously been reported that the plasma protein concentration in affected infants was abnormally low. It was attempted further to establish biochemical and/or immunological criteria for diagnosis of the disease and to discover reasons for the low IgG concentrations and raised α-fetoprotein concentrations found in the sera of these infants. Maternal serum proteins were also studied during pregnancy and at and after delivery of the infant. Interrelationships between α-fetoprotein, Human Growth Hormone and other proteins, in immunochemical systems were investigated. In summary, the main conclusions reached were as follows: (i) The total serum-protein concentration in affected infants is much reduced, as compared with healthy premature infants of the same gestational age. (ii) In IRDS infants, the relative and absolute concentration, of IgG is extremely low, whereas concentrations of other immune globulins, as far as could be determined, are within normal limits. (iii) Mothers of affected infants have significantly lower concentrations both of serum IgG and of IgM, than mothers of healthy premature infants. These changes in the serum-proteins are present throughout pregnancy. By six weeks post-partum, the IgG level has returned to normal, but the IgM level remains low. Concentrations of IgA and total serum-protein are normal at all times. (iv) Examination of oedema fluid, urine, faeces and amniotic fluid for γ-globulin content, has excluded the possibility that IgG is being lost from the circulation by these routes. (v) IRDS infants have, in their serum, agglutinins of the IgM type directed against the intact maternal IgG molecule. Similar agglutinins are present in a minority of healthy premature infants. Both IRDS and healthy infants have agglutinins against IgG fragments, in approximately 50% of cases. Agglutinin titres against these are similar in the two groups, but the incidence of agglutinins against Bence Jones protein type Lis raised in IRDS. (vi) Affected infants have an elevated serum concentration of α-fetoprotein, which disappears from the serum during the: first week of post-natal life. (vii) The majority of pregnant women examined have been observed to have serum agglutinins directed against α-fetoprotein. These cross-react with albumin prepared from sera of healthy adult males α-fetoprotein has been found in the serum of many pregnant women, especially during the second trimester. (viii) Immunological interrelationships between α-fetoprotein human serum albumin, Human Growth Hormone and human IgG have been demonstrated. (ix) Infants suffering from Rh-isoimmunization exhibit a serum- protein pattern similar to that seen in IRDS. Biochemical and immunological criteria for the diagnosis of IRDS have thus been established. The data to be presented indicate the presence of an immunological factor in the aetiology of the disease.
Advisors/Committee Members: Kench, J E (advisor).

Hixon SJ. An investigation of the psychometric properties of a
clinical simulation examination for respiratory care practitioners
. [Doctoral Dissertation]. The Ohio State University; 1985. Available from: http://rave.ohiolink.edu/etdc/view?acc_num=osu1487261919111437

► Critical care nursing is a speciality that continues to evolve and transform. Critical care nurses of the 21st century routinely care for the complex, critically…
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▼ Critical care nursing is a speciality that continues to evolve and transform. Critical care nurses of the 21st century routinely care for the complex, critically ill patient, integrating sophisticated technology with the accompanying psychosocial challenges and the ethical conflicts associated with critical illness – while, at the same time, addressing the needs and concerns of the family. Providing nursing care in such a dynamic and fast-track unit can pose various challenges for the critical care nurse. Professional nurses are the backbone of any health-care system. The quality of nursing directly affects the patients’ outcomes, and nursing care must therefore be rendered meticulously. Mechanical ventilator support is routinely needed for critically ill adults in these care units and is also a common therapy in sub-acute and long-term care settings. The care of the mechanically ventilated patient is the core of a professional nurse`s practice in the critical care unit. The mechanically ventilated patient presents many challenges for the professional nurse, while the critical care unit poses as a stressful environment for the professional nurse as well as the patient. The objectives of this study therefore were to explore and describe the lived experiences of professional nurses while caring for mechanically ventilated patients, and to develop recommendations to support professional nurses while caring for mechanically ventilated patients. A qualitative, explorative, descriptive and contextual research design was utilised. Data was collected by means of semi-structured interviews and analysed according to the framework provided by Tesch. Purposive sampling was used to select a sample of professional nurses working in a critical care environment. Guba’s model was utilised to verify data and to ensure trustworthiness of the study. Ethical principles were adhered to throughout this research study. With the analysed data, recommendations were to support professional nurses while caring for mechanically ventilated.

► Background: In the United States, minorities are numerous and account for 28% of the population. It is well known that some of the cultural…
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▼ Background: In the United States, minorities are numerous and account for 28% of the population. It is well known that some of the cultural elements are related to the patients’ health. Therefore, it is an obligation of healthcare providers to become culturally competent to improve minorities’ overall healthcare.
PURPOSE: This study was conducted to assess the cultural attitudes, skills, and knowledge of undergraduate and graduate respiratorytherapy (RT) students at an urban university located in the southeastern United States.
METHODS: The study used a descriptive exploratory design with a self-reporting survey. The survey instrument used was a short version of the Cultural Competence Self-Assessment “ASK” (Attitude–Skills–Knowledge) Scale. The survey was administered to a convenience sample of first and second-year BSRT and MSRT students attending an accredited RT program. The survey consisted of 24 items on a five-point Likert scale. The collected data were analyzed using descriptive statistics and independent samples t-test.
RESULTS: Fifty-three students were surveyed; around two-thirds of the respondents were female. Sixty-eight percent of respondents were BSRT and 22% were MSRT students. First-year students accounted for 56.6% of the respondents and second-year students accounted for 43.4%. The majority of the respondents were under the age of 25. The respondents reported to be ready to practice in the attitude and skills subscale (4.49±.49, 4.20±.62 respectively) but they need practice based on the knowledge subscale (3.80±.86). The statistically significant findings were found between first-year and second-year respondents in the skills subscale, knowledge subscale, and the total scale. However, there were no statistically significant difference between BSRT and MSRT students.
CONCLUSION: This study found that respondents made progress throughout the RT program. Also, it found that level of education has no effect on cultural competency. This may be because student’s level of cultural competence improves as they advance in their clinical course work and their educational training. The results may assist RT educators to recognize the students’ needs for more information to improve their cultural competency.
Advisors/Committee Members: Dr. Lynda T. Goodfellow, Ralph D. Zimmerman, Robert B. Murray.

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

University of Gothenburg / Göteborgs Universitet

28.
Bergbom-Engberg, Ingegerd, 1947-.
Patients' experiences of respirator treatment : a retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity.

Bergbom-Engberg, Ingegerd, 1. (1989). Patients' experiences of respirator treatment : a retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity. (Thesis). University of Gothenburg / Göteborgs Universitet. Retrieved from http://hdl.handle.net/2077/13882

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Bergbom-Engberg, Ingegerd, 1947-. “Patients' experiences of respirator treatment : a retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity.” 1989. Thesis, University of Gothenburg / Göteborgs Universitet. Accessed September 15, 2019.
http://hdl.handle.net/2077/13882.

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Bergbom-Engberg, Ingegerd 1. Patients' experiences of respirator treatment : a retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity. [Thesis]. University of Gothenburg / Göteborgs Universitet; 1989. Available from: http://hdl.handle.net/2077/13882

Note: this citation may be lacking information needed for this citation format:Not specified: Masters Thesis or Doctoral Dissertation

► A main problems for premature infants is respiratory distress syndrome (IRDS), also called neonatal respiratory distress syndrome, or respiratory distress syndrome of newborn. Due to…
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▼ A main problems for premature infants is respiratory distress syndrome (IRDS), also called neonatal respiratory distress syndrome, or respiratory distress syndrome of newborn. Due to IRDS, the infant requires intervention in the form of respiratory support to increase the inspired oxygen. Physicians must keep the range of the Arterial Oxygen Saturation (SpO_2) between 82 – 95% to help the premature infants to get oxygen enough while preventing other complications. If the blood oxygen saturation is more than 95% or less than 82%, the infant is at risk for retinopathy of prematurity. The control is analyzed using PI, PID, Model Predictive Controller (MPC), Robust control wit PID and Robust control with MPC to ensure stability and minimum settling time to reach the accuracy of output SpO_2 by applying the Fraction of Inspired Oxygen (FiO_2) as control action. MPC is an optimal control strategy based on numerical optimization by using a system model and optimizing at regular intervals. We can predict the future control inputs and future plant responses. An error model is created using the resulting ranges of system gains and time constant from [18]. The ?-synthesis controller is developed to control the oxygen percentage of inspired air and performance specifications are defined. The H_? method is used to determine the robust stability and robust performance are achieved with the system uncertainty that described by the error model. A comparison among a static proportional integral, proportional integral derivative, the model predictive controller, the robust controller with PID controller, and the robust controller with MPC found that the robust controller with MPC displays the best performance for a system with large ranges of model parameters. The results got from this dissertation are ; PI controller has large overshoots and large steady state error when using large values of K_I but when decreasing the values of K_I got good response with low overshoot and zero steady, PID controller has large overshoots and large steady state error when using large values of K_I and small values of K_p but when decreasing the values of K_I and increasing values of K_p got good response with low overshoot and zero steady, MPC controller has a zero steady state error and no peak overshoot and achieves SpO_2 to be a minimum settling time of 105 sec and zero steady state error, in robust control system based on the PID that showed the results of controller can guarantee stability and performance for whole range of model parameters and robust model predictive controller was analyzed, we did get the robust stability, nominal performance and robust performance. The robust controller is found to have a robust stability and performance, but with a low bandwidth frequency due to a conservative control design required to achieve robust stability with an extremely high level of model error. The main goal of the robust controller was analyzed for performance and stability. It was shown to be more nominally stable and have nominal performance…
Advisors/Committee Members: Fales, Roger (advisor).

► The purpose of this study was to evaluate which pre-oxygenation technique used pre-suctioning was most effective in minimizing hemoglobin de-saturation in patients dependent on positive-end…
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▼ The purpose of this study was to evaluate which pre-oxygenation technique used pre-suctioning was most effective in minimizing hemoglobin de-saturation in patients dependent on positive-end expiratory pressure (PEEP). A quasi-experimental design was implemented with each subject serving as his own control. Each subject (N=14) was exposed to two different pre-oxygenation techniques prior to suctioning. The majority of the subjects were trauma victims with head injuries and aspiration pneumonia. Total of 33 paired protocols was obtained. Findings demonstrated that either pre-oxygenation procedure will prevent a significant change of oxygen saturation of hemoglobin in arterial blood (SaO2) in PEEP dependent patients during suctioning. Pre-oxygenation by ventilator is suggested as the preferred technique when suctioning patients whose arterial oxygen tension (PaO2) is initially low and they are vulnerable to hypoxemia. Unconditional recommendation is not possible for the sample population on 10 cm of PEEP or more. An increase occurrence of complications suggests the need for further investigation.